前列腺特异性抗原（PSA）谷值和前列腺癌低剂量率近距离治疗后 PSA 反弹的经历可预测临床失败。

Prostate-specific antigen (PSA) nadir and experience of PSA bounce after low-dose-rate brachytherapy for prostate cancer predicts clinical failure.

机构信息

Department of Urology, Nara Medical University, Nara, Japan; Department of Prostate Brachytherapy, Nara Medical University, Nara, Japan.

出版信息

Brachytherapy. 2024 Nov-Dec;23(6):727-736. doi: 10.1016/j.brachy.2024.09.003. Epub 2024 Oct 5.

DOI:10.1016/j.brachy.2024.09.003

PMID:39368902

Abstract

OBJECTIVE

This study aimed to assess if prostate-specific antigen (PSA) threshold and PSA bounce are associated with oncological control after low-dose-rate brachytherapy (LDR-BT) alone or with external beam radiotherapy (EBRT), with or without androgen deprivation therapy (ADT), considering serum testosterone levels.

METHODS

This study enrolled 944 prostate cancer patients treated at a single institution with LDR-BT alone or LDR-BT combined with EBRT, with or without ADT. The Fine-Gray hazard model was used to evaluate factors related to clinical failure, including experience of PSA bounce between baseline and 2, 4, or 7 years after LDR-BT and PSA value (0.1, 0.2, or 0.5 ng/mL) with normal testosterone levels at 2, 4, and 7 years after LDR-BT, respectively.

RESULTS

Patients with normal testosterone levels and a PSA of 0.2 or 0.5 ng/mL at 2, 4, and 7 years after LDR-BT had a significantly better clinical failure free rate (CFFR) than those with PSA levels >0.2 or >0.5 ng/mL or low testosterone levels. Multivariate analysis revealed that PSA <0.1, 0.2, or 0.5 ng/mL with normal testosterone levels at 2, 4, and 7 years and experience of PSA bounce between baseline and 2 or 4 years after LDR-BT were significantly related to better CFFR.

CONCLUSIONS

Patients with normal serum testosterone levels who reached PSA of <0.1, 0.2, or 0.5 ng/mL after LDR-BT, or those who experienced PSA bounce, showed better oncological control.

摘要

目的

本研究旨在评估在低剂量率近距离放射治疗（LDR-BT）单独或联合外部束放射治疗（EBRT）、联合或不联合雄激素剥夺治疗（ADT）后，考虑到血清睾酮水平，前列腺特异性抗原（PSA）阈值和 PSA 反弹是否与肿瘤控制相关。

方法

本研究纳入了 944 名在单一机构接受 LDR-BT 单独或 LDR-BT 联合 EBRT 治疗、联合或不联合 ADT 的前列腺癌患者。使用 Fine-Gray 风险模型评估与临床失败相关的因素，包括 LDR-BT 后 2、4 或 7 年期间 PSA 反弹的经历以及 LDR-BT 后 2、4 和 7 年时 PSA 值（0.1、0.2 或 0.5ng/mL）与正常睾酮水平。

结果

LDR-BT 后 2、4 和 7 年时，血清睾酮水平正常且 PSA 值为 0.2 或 0.5ng/mL 的患者的临床无失败率（CFFR）显著优于 PSA 值>0.2 或>0.5ng/mL 或睾酮水平低的患者。多变量分析显示，LDR-BT 后 2、4 和 7 年时 PSA<0.1、0.2 或 0.5ng/mL 且血清睾酮水平正常以及 LDR-BT 后基线和 2 或 4 年之间出现 PSA 反弹与更好的 CFFR 显著相关。